Induced Abortion Guidelines - Summary of Recommendations

Summary of Recommendations

1. Manual vacuum aspiration can be performed safely and effectively in an office setting up to 10 weeks' gestation. (B)

2. A cannula size in mm equal to or greater than the gestational age in weeks should be used for manual vacuum aspiration. (B)

3. First and second trimester abortions should be performed by experienced personnel in hospitals or outpatient facilities. (B)

4. If bacterial vaginosis is suspected, the patient should be treated with metronidazole perioperatively. (A)

5. Pre-abortion screening should include Rh status, and cervical cultures for sexually transmitted infections and bacterial vaginosis.
Cervical cytology and sickle cell testing should be done when appropriate. (A)

6. Medical abortion with misoprostol and methotrexate should be considered in carefully selected patients who will be compliant with follow-up. (A)

7. A follow-up system must be in place to provide for surgical evacuation of the uterus if medical abortion fails. (A)

8. Ultrasound or measurement of βhCG levels should be used in follow-up in order to determine whether or not the uterus has been evacuated after medical abortion. (B)

9. A paracervical block with 0.5% or 1% lidocaine should be placed before vacuum aspiration. (B)

10. Pre-procedural dilatation of the cervix may be considered.
Synthetic or osmotic dilators, laminaria tents, or misoprostol may be used. (B)

11. Perioperative prophylaxis antibiotic coverage should be used routinely in order to reduce the incidence of post-abortal infection. (A)

12. Physicians using intravenous medications and local anaesthesia must be trained in resuscitation and management of complications arising from the use of these medications. (B)

13. Gross examination of the fresh tissue must be made after surgical abortion. (A)

14. Medical induction and D&E are both safe and effective methods of second trimester termination. However, D&E is considered superior between 14 and 18 weeks' gestation. The particular technique should be selected according to the expertise of the physician and wishes of the patient. (B)

15. Oral, rectal, or buccal misoprostol, oxytocin infusion (intraoperatively or postoperatively), and intracervical injection of vasopressin, alone or in combination, should be performed with D&E in gestations longer than 14 weeks. (B)

16. Further research is needed to determine optimal regimens for medical termination in the first and second trimester. (B)

Validation: This guideline has been reviewed by the Clinical Practice - Gynaecology Committee and the Social and Sexual Issues Committee and approved by the Executive Council of the Society of Obstetricians and Gynaecologists of Canada.